Provider Demographics
NPI:1942360490
Name:ALLEGANY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ALLEGANY COUNTY HEALTH DEPARTMENT
Other - Org Name:ACHD-LOIS E. JACKSON UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:301-759-5001
Mailing Address - Street 1:PO BOX 1745
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1745
Mailing Address - Country:US
Mailing Address - Phone:301-759-5000
Mailing Address - Fax:301-777-5674
Practice Address - Street 1:10102 COUNTRY CLUB RD SE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-8339
Practice Address - Country:US
Practice Address - Phone:301-777-2290
Practice Address - Fax:301-777-2141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEGANY COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162973245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
055998OtherPRIORITY PARTNERS (MCO)
02IOOtherMAGELLAN
351541OtherMAMSI
MD603304100Medicaid
5098907OtherUBH (MCO)
IOOtherMAGELLAN
323817OtherVALUE OPTIONS
NU1OtherGHMSI
277593OtherMAMSI
604116-02OtherCAREFIRST BCBS